MEDICARE: GROUNDED MINDS COUNSELING, CONSULTING & SUPERVISION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1275495079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROUNDED MINDS COUNSELING, CONSULTING & SUPERVISION, LLC

Provider Business Mailing Address
First Line	:	8891 BRIGHTON LN STE 105
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-7526
Country	:	US
Telephone Number	:	239-499-2872
Fax Number	:

Provider Business Practice Location Address
First Line	:	8891 BRIGHTON LN STE 105
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-7526
Country	:	US
Telephone Number	:	239-499-2872
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CLINICAL DIRECTOR, LMHC
Name	:	KATIE STABILE
Credential	:	LMHC
Telephone Number	:	239-499-2872

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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